Claudia Christine Sidler-Maier1, Nicolas J Dedy2, Emil H Schemitsch3, Michael D McKee4. 1. 1Division of Trauma and Orthopaedic Surgery, Upper Limb Surgery, Ashford & St. Peter's Hospital, Guildford Road, Chertsey, Surrey KT16 0PZ UK. 2. 2Department of Orthopaedic Surgery, Krankenhaus Barmherzige Brüder, Regensburg, Germany. 3. 3Department of Orthopaedic Surgery, London Health Sciences Centre, St. Joseph's Health Care, London, ON Canada. 4. 4Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Abstract
BACKGROUND: Successful treatment of clavicle malunion represents a major challenge for orthopedic surgeons. QUESTIONS/PURPOSES: The aim of this study was to provide an overview of surgical options for the treatment of clavicle malunions regarding their technical details and clinical results. METHODS: A comprehensive search of the literature was performed to retrieve articles and conference abstracts regarding the surgical treatment of clavicle malunions. A total of 1873 records were identified and 29 studies were included in the present review, with a total of 103 patients. RESULTS: The majority of the patients (77/103) were treated with an osteotomy and subsequent open reduction internal fixation (ORIF). The next most frequent management choice was debridement, excision, or removal of excess callus or bone (n = 19), but other techniques like resection of the clavicle (n = 5) or nerve exploration and decompression (n = 2) were also reported. The preferred method of fixation was plate fixation (n = 53) followed by pin fixation (n = 6). The complication rate was low, reported in less than 6% of patients. CONCLUSION: All of the currently reported surgical techniques to manage symptomatic clavicle malunion have resulted in good clinical outcomes with a low complication rate. Considering biomechanical aspects, correction osteotomy followed by plate fixation seems to be the preferred method. Further studies are needed to compare the various surgical techniques and their specific outcomes in a prospective manner. Nevertheless, this review article can be used as an overview to help choose an optimal operative treatment for patients presenting with a clavicle malunion.
BACKGROUND: Successful treatment of clavicle malunion represents a major challenge for orthopedic surgeons. QUESTIONS/PURPOSES: The aim of this study was to provide an overview of surgical options for the treatment of clavicle malunions regarding their technical details and clinical results. METHODS: A comprehensive search of the literature was performed to retrieve articles and conference abstracts regarding the surgical treatment of clavicle malunions. A total of 1873 records were identified and 29 studies were included in the present review, with a total of 103 patients. RESULTS: The majority of the patients (77/103) were treated with an osteotomy and subsequent open reduction internal fixation (ORIF). The next most frequent management choice was debridement, excision, or removal of excess callus or bone (n = 19), but other techniques like resection of the clavicle (n = 5) or nerve exploration and decompression (n = 2) were also reported. The preferred method of fixation was plate fixation (n = 53) followed by pin fixation (n = 6). The complication rate was low, reported in less than 6% of patients. CONCLUSION: All of the currently reported surgical techniques to manage symptomatic clavicle malunion have resulted in good clinical outcomes with a low complication rate. Considering biomechanical aspects, correction osteotomy followed by plate fixation seems to be the preferred method. Further studies are needed to compare the various surgical techniques and their specific outcomes in a prospective manner. Nevertheless, this review article can be used as an overview to help choose an optimal operative treatment for patients presenting with a clavicle malunion.
Authors: Jeffrey M Potter; Caroline Jones; Lisa M Wild; Emil H Schemitsch; Michael D McKee Journal: J Shoulder Elbow Surg Date: 2007-07-12 Impact factor: 3.019